Reference

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how
you can access this information.

PLEASE REVIEW THIS INFORMATION CAREFULLY.

LEGAL DUTY

We are required by federal and state law to maintain the privacy of your health
information. We are also required to give you this notice about our privacy practices,
our legal duties and your rights concerning your health information. We must follow the
privacy practices that are described in this notice while it is in effect. We have the
right to change our privacy practices; if we do so, we will notify you of these
changes.

USE AND DISCLOSURES OF HEALTH INFORMATION

We are permitted, by law, to use and disclose health information about you for reasons
concerning treatment, payment and healthcare operations. Examples:

Treatment: We may disclose your health information to a physician or other healthcare provider that is providing treatment or other health services to you.

Payment: We may use and disclose your health information to obtain payment for services that we provide you.

Operations: We may use and disclose your health information in connection with our healthcare operations, which include administration and planning and other tasks that help us improve that quality.

Family and Friends: We may disclose your health information to a family member, relative or a friend that has been identified by you while you are present. If you are not present, professional judgment will be utilized to determine whether a disclosure is required or in your best interest. We will only disclose information that is believed to be relevant to the person’s involvement with your health care or payment related to your health care. We may also disclose your health information in order to notify such persons of your location, general condition or death.

Requirements of the Law: : We may use or disclose your health information when we are required to do so by law.

Victim of Abuse or Neglect: We may disclose your health information to authorities if reasonable belief is that you are a possible victim of abuse, neglect or domestic violence. We may disclose information to the extent necessary to avert additional serious threat to your health or safety or the health or safety of others.

Public Health Activities: We may disclose your health information to public health authorities for the purpose of preventing or controlling disease or preventing injury; to alert a person who may have been exposed to a communicable disease; to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; to report information to a health oversight agency that is responsible for ensuring compliance with governmental rules and regulations, such as Medicare and Medicaid.

National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counter intelligence and other national security activities.

Worker’s Compensation: We may use or disclose your health information to the extent necessary to comply with state laws relating to workers’ compensation.

Disclosures Requiring your Authorization: For any reasons other than those listed in this notice, we may only use or disclose your health information with your written authorization. Your authorization must also be obtained prior to using your health information for any marketing activity.

YOUR RIGHTS TO YOUR PERSONAL HEALTH INFORMATION

Access to Record: You may have access to your health information, with limited exceptions. Requests must be submitted in writing to the address included in this notice. We may charge a reasonable fee to compensate for time and materials.

Revocation of your Authorization: You may revoke your authorization to disclose your health information at any time. Requests must be submitted in writing to the address included in this notice.

Restriction of Information: You may request that we place restrictions on our use or disclosure of your health information. Requests must be submitted in writing to the address included in this notice. We will respond to all such requests in writing.

Disclosure Accounting: You may request a list of instances in which we (or our business associates) disclosed your health information for purposes, other than treatment, payment, Healthcare operations and certain other activities, for the last 6 years. You must make your request in writing by sending us a letter that specifies the type of information and the time period involved. Requests should be sent directly to the address listed in this Notice.

Alternative Communication: You may request that we communicate with you about your health information by alternative means or to an alternative location. You must make your request in writing by sending a letter that specifies the alternative means or location and provide satisfactory explanation how payments will be handled under the alternative means or location you have requested. Requests should be sent directly to the address listed in the header of this Notice.

Amendment: You have the right to request that we amend your health information. You must make your request in writing by sending us a letter that explains why the information should be amended. Requests should be sent directly to the address listed in the header of this Notice. We will comply with your request unless we believe that the information to be amended is accurate and complete.

QUESTIONS OR COMPLAINTS

If you are concerned that we may have violated your privacy rights, would like to amend your medical records, request an accounting of disclosures or have questions about how your information is used, please let us know.

You may also submit a written complaint to the U.S. Department of Health and Human Services. Additionally, you may file a complaint with our accrediting body, Agency for Health Care Administration at 919-785-1214.

Supplier Standards

Note: This is an abbreviated version of the supplier standards every Medicare DMEPOS supplier must meet in order to obtain and retain their billing privileges. These standards, in their entirety, are listed in 42 C.F.R. 424.57(c).

Medicare DMEPOS Supplier Standards

A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements and cannot contract with an individual or entity to provide licensed services.

A supplier must provide complete and accurate information on the DMEPOS supplier application. Any changes to this information must be reported to the National Supplier Clearinghouse within 30 days.

An authorized individual (one whose signature is binding) must sign the application for billing privileges.

A supplier must fill orders from its own inventory, or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State healthcare programs, or from any other Federal procurement or non-procurement programs.

A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment, and of the purchase option for capped rental equipment.

A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable state law, and repair or replace free of charge Medicare covered items that are under warranty.

A supplier must maintain a physical facility on an appropriate site. This standard requires that the location is accessible to the public and staffed during posted hours of business. The location must be at least 200 square feet and contain space for storing records.

A supplier must permit CMS, or its agents to conduct on-site inspections to ascertain the supplier’s compliance with these standards. The supplier location must be accessible to beneficiaries during reasonable business hours, and must maintain a visible sign and posted hours of operation.

A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory assistance. The exclusive use of a beeper, answering machine, answering service or cell phone during posted business hours is prohibited.

A supplier must have comprehensive liability insurance in the amount of at least $300,000 that covers both the supplier’s place of business an all customers and employees of the supplier. If the supplier manufactures its own items, this insurance must also cover product liability and completed operations.

A supplier must agree not to initiate telephone contact with beneficiaries, with a few exceptions allowed. This standard prohibits suppliers from contacting a Medicare beneficiary based on a physician’s oral order unless an exception applies.

A supplier is responsible for delivery and must instruct beneficiaries on use of Medicare covered items, and maintain proof of delivery.

A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.

A supplier must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare covered items it has rented to beneficiaries.

A supplier must accept returns of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries.

A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare covered item.

A supplier must disclose to the government any person having ownership, financial, or control interest in the supplier.

A supplier must not convey or reassign a supplier number; i.e., the supplier may not sell or allow another entity to use its Medicare billing number.

A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility.

Complaint records must indicate: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.

A supplier must agree to furnish CMS any information required by the Medicare statute and implementing regulations.

All suppliers must be accredited by a CMS approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services, for which the supplier is accredited in order for the supplier to receive payment of those specific products and services (except for certain exempt pharmaceuticals). Implementation Date – October 1, 2009

All suppliers must notify their accreditation organization when a new DMEPOS location is opened.

All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare.

All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation.

A supplier must maintain ordering and referring documentation consistent with provisions found in 42 C.F.R. 424.516(f).

DMEPOS suppliers are prohibited from sharing a practice location with certain other Medicare providers and suppliers.

DMEPOS suppliers must remain open to the public for a minimum of 30 hours per week with certain exceptions.

Disclaimer

The information contained on this website is not a substitute for medical advice and is strictly for informational and educational purposes. It is for reference only. Always consult your physician or healthcare provider to determine your treatment plan or for any other questions you may have regarding your medications or treatment.

Consultations or information received from our Customer Care Team are not intended to replace your physicians medical advice or treatment plan.

Limited Warranty

Subject to the terms below, Advance Diabetic Supply provides the following limited warranty for the products. Advance Diabetic Supply warrants to the patient that any products purchased will be free from defects in materials and workmanship during the warranty period applicable to each such product. Warranty periods, which vary by product, may be obtained by calling Advance Diabetic Supply’s Customer Care Department. The warranty period commences on the date of shipment.

Advance Diabetic Supply’s sole obligation for this limited warranty is to repair or replace a defective product at no charge to Patient, or to credit Patient’s account for the purchase price paid for the defective product, at Advance Diabetic Supply’s discretion. This limited warranty does not apply if the defective product (i) is subject to abuse, neglect, misuse, or accident, (ii) has not been used in accordance with Advance Diabetic Supply’s written instructions for use (IFU), (iii) was not purchased from Advance Diabetic Supply or an authorized dealer of Advance Diabetic Supply, or (iv) was modified from its original configuration or repaired or altered by anyone other than Advance Diabetic Supply or a person authorized by Advance Diabetic Supply. To make a warranty claim, Advance Diabetic Supply’s Customer Care Department must be contacted within five days of discovery of the defect to obtain a return authorization number.

Advance Diabetic Supply will be responsible for shipping costs on defective products that are under warranty which are returned by Patient to Advance Diabetic Supply with a return authorization number. Replaced or repaired product will be shipped to Patient at Advance Diabetic Supply’s expense. Other warranty terms and limitations may apply to certain products.

Actions that may void the Limited Warranty:

The warranty period has expired,

the item or defect is not covered under warranty,

product failure due to damage, destruction or misuse of product,

excessive wear or,

modifications or alterations to the product.

ADVANCE DIABETIC SUPPLY HEREBY DISCLAIMS ANY OTHER EXPRESS OR IMPLIED WARRANTIES NOT SET FORTH IN THE FOREGOING LIMITED WARRANTY, INCLUDING, BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. ADVANCE DIABETIC SUPPLY WILL NOT BE LIABLE FOR ANY INDIRECT, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES OR LOST PROFITS, CAUSED BY ANY PRODUCT DEFECT WHETHER CLAIMS ARE BASED UPON TORT (INCLUDING NEGLIGENCE), WARRANTY, CONTRACT OR OTHERWISE, EVEN IF ADVANCE DIABETIC SUPPLY HAS BEEN ADVISED OF SUCH POTENTIAL LOSS OR DAMAGE. TO THE EXTENT THE FOREGOING DISCLAIMERS ARE NOT ALLOWED BY APPLICABLE LAW, ANY IMPLIED WARRANTIES WILL BE LIMITED TO THE DURATION OF THE EXPRESS LIMITED WARRANTY APPLICABLE TO THE PRODUCT. SOME STATES DO NOT ALLOW LIMITATIONS ON HOW LONG AN IMPLIED WARRANTY LASTS, OR THE EXCLUSION OR LIMITATION OF INCIDENTAL OR CONSEQUENTIAL DAMAGES SO THE ABOVE LIMITATIONS MAY NOT APPLY TO PATIENT. UPON ANY MEDICAL RELATED CLAIM, THE PATIENT MUST CONSULT WITH THEIR PHYSICIAN IMMEDIATELY.